Non-Communicable Disease Primer: Where Does the World Stand?

Before the United Nations launches into debate on the Palestinian territories and other contentious international political issues next week, it will take two days to discuss a growing health crisis that is killing people every day: non-communicable diseases.

More than 36 million people die each year around the globe from diabetes, cancer, and heart and lung disease. That’s more than the number of deaths from all infectious diseases combined. But perhaps a more telling measure of the current epidemic and its trajectory is that 9 million of these deaths are premature, and 90 percent of those premature deaths occur in low-and-middle income countries.

Advocates have long struggled to raise the profile of these conditions, but in the run up to the summit a slew of data and reports on the human costs have helped bring the scale of the situation into focus.

Get up to speed on the status of these diseases and some of the proposed actions from the finalized U.N. draft agreement:

Heart Disease

Heart attacks and strokes are the most visible, traumatic manifestations of cardiovascular disease, but this group also includes malformations of the heart and chronic disease of the blood vessels supplying the heart and brain.

About 13.5 million deaths were caused by heart disease and stroke in 2008, and the number of cases is accelerating — by the year 2030, an estimated 23.6 million will die of these causes.

“Over the past two decades deaths from [cardiovascular diseases] have been declining in high-income countries, but have increased at an astonishingly fast rate in low- and middle-income countries,” said Pekka Puska, a board member of the World Heart Federation.

Lack of access to care contributes to the gap in outcomes of the diseases, but lifestyle choices are a danger everywhere for developing heart conditions. Cardiovascular disease is largely preventable — about 80 percent of cases can be tied to behavioral risk factors like poor diet, lack of exercise, smoking and excessive use of alcohol, according to the World Health Organization.

Cancer

The number of cancer deaths around the globe is projected to increase by 45 percent by 2030, to 11.5 million deaths. The most devastating forms of the disease in terms of deaths are cancers of the lung, stomach, colon, liver and breast. Lung cancer causes the most deaths by far, about 1.3 million a year.

Like heart disease, most cancer cases are now found in the developing world. But in contrast with cardiovascular disease, which is primarily preventable through behavior change, only 30 percent of cancer cases are linked to behavioral or environmental factors that could be modified. Tobacco use is the single largest preventable cause, linked to 1.8 million cancer deaths a year.

World Health Organization Director Margaret Chan said in previous remarks on non-communicable disease there is “an almost total lack of response capacity in the developing world” for cancers.

“This is a lack of capacity for prevention, public education, screening and early detection, diagnosis and treatment, whether involving surgery, radiotherapy, or chemotherapy,” Chan said.

Chronic Respiratory Diseases

Asthma, bronchitis, emphysema and chronic obstructive pulmonary disease are all conditions that make breathing difficult and cause about 4 million deaths a year. Incidence of these diseases is increasing everywhere in the world, and experts say tobacco and environmental factors are two big contributors.

Cooking and heating with biomass fuels alone could account for about 1.5 million respiratory-related deaths in low-and-middle income countries each year, according to Neil Schluger, chief scientific officer at the World Lung Foundation.

“This creates levels of air pollution in homes that are astronomical, hundreds of times more than what you might breathe in New York, for example,” he said.

Diabetes

The number of people living with diabetes has soared to 366 million and 4.6 million* people die each year from the disease, according to new figures from the International Diabetes Federation. The vast majority of those cases are type 2, linked to obesity, poor diet and lack of exercise. The Federation points to rapid development and urbanization leading to sharp increases in type 2 diabetes.

Regionally, North America and the Middle East currently have the highest rate of diabetes, while at the country level China and India have the largest diabetic populations.

Jesper Hoiland, senior vice president at Novo Nordisk, the largest producer of insulin in the world, said an estimated 10 to 15 percent of people with diabetes in the world are getting the insulin they need for proper glycemic control. The company has observed fast growth in demand for insulin in the developing world.

So what should be done?

The U.N. meeting’s 14-page, 57-point draft political agreement on reducing non-communicable disease has already been agreed upon by country representatives. The document does not include any hard targets but outlines an approach to preventing the growth of the conditions and pushes for better access to treatment.

A few highlights from the behavioral risk factor recommendations:

Encouraging countries to implement the WHO Framework Convention on Tobacco Control, measures to reduce availability of tobacco products and recognizing that price and tax measures work to reduce tobacco consumption.

Promoting WHO recommendations on food and beverage marketing to children. “Research shows that food advertising to children is extensive, that a significant amount of the marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children’s food preferences,” the draft reads.

Work towards reducing the use of salt in the food industry in order to lower sodium consumption.

Encouraging healthy diets and physical activity in the general population, including through physical education in schools, urban planning for increased activity and work-site health initiatives.

A few highlights from the health system recommendations:

Recognize the importance of universal coverage in national health systems.

Improve access and affordability for medicines and technologies for NCDs.

Work to train and retain more health workers.

Improve diagnosis, laboratory and imaging services for better early detection.

With the document hammered out, and no funding pledges expected from countries, the anticipation going into Monday’s meetings is focused on who represents the countries at the high-level meeting, and how committed countries sound to carrying out the document’s recommendations.

Editor’s Note: Due to an editing error, the initial posting of this story omitted the word “million” from how many people die each year of diabetes. This version has been corrected.